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Abstract

Introduction: Ischemic stroke complicates hypertrophic cardiomyopathy (HCM), but little is known about the epidemiology of stroke in patients(pts) with HCM as opposed to stroke in pts without HCM.

Methods: Using administrative data from the Nationwide Inpatient Sample (NIS) in years 2000-2009, we analyzed all cases of acute ischemic stroke and transient ischemic attack (TIA) requiring hospitalization in patients with HCM. We matched these pts by year of admission with a random sample of stroke and TIAs in non-HCM pts.

Results: We analyzed 540 cases of acute stroke/TIA in pts with HCM compared to 2164 cases of acute stroke/TIA in pts without HCM. Mean age and prevalence of hypertension were similar in both groups (Table). In this population of stroke pts, atrial fibrillation was 3.3 (95% CI 2.6-4.0) times more common in HCM group than non-HCM group. Additional characteristics more common in HCM group were female gender (OR 1.7, 95% CI 1.4-2.0), congestive heart failure (OR 2.0, 95% CI 1.5-2.6), and valvular heart disease (OR 3.4, 95% CI 2.6-4.4). Length of hospital stay was one day longer (5.4 days vs. 4.2 days, p<.0001) and routine discharge to home was less frequent (51.9% vs. 61.1%, p<.01) in the HCM compared to non-HCM group. There was no change in which outcomes were statistically significant after adjusting for age and comorbidity score. However, after controlling for the characteristics that differ significantly between HCM and non-HCM groups in Table 1, routine discharge became statistically non-significant (p<0.07). This was due to the addition of atrial fibrillation to the model. There was no significant difference in in-hospital mortality after stroke.

Conclusions: In the largest case series accumulated of stroke/TIAs in HCM patients, key differences were seen in the clinical risk profile and outcomes of stroke compared to non-HCM controls. This suggests that a unique approach should be taken in dealing with patients with HCM who suffer from stroke.